We ignore the past at our peril

Almost £650 million – it’s a sizeable chunk of money. So why has it received a cautious welcome? By Malcolm Harrison 

After several delays, NHS England has finally released its hotly anticipated plan for the recovery of primary care. No-one in the sector will have missed the headline-grabbing announcement that up to £645m will be made available to community pharmacy over two years, for delivering on existing services, to develop digital infrastructure and to launch a Pharmacy First service.

What’s not to like? All the pharmacy bodies, the CCA included, have welcomed this news, but perhaps not as warmly as some might have expected. So, with £645m on the table for an industry starved of funding for almost a decade, why the hesitancy?

I suspect that the cautious welcome is born out of experience in the past. Community pharmacy practice has come a long way over the past 20 years: from purely dispensing prescribed medicines to delivering first MURs and then the NMS, flu jabs, Community Pharmacist Consultation Service (CPCS), Covid vaccinations, blood pressure testing, and oral contraception.

But the sad irony is that of all these services, just one was conceived, designed, negotiated and delivered at pace, on time, at scale and in a way that meant contractors were able to earn a fair return – and it was never part of the plan for pharmacy in the first place. Can you guess which?

The rest all had difficult births and have tended to fall short of the ambitious targets NHSE so enthusiastically trumpeted when launching them. By and large, they continue to fly under the public radar.

So, what can we learn from lacklustre launches over the past 20 years? Firstly, it takes two to tango.

The process of NHSE and the DHSC locking horns with Community Pharmacy England as they ‘negotiate’ each service specification has a history of becoming protracted and getting bogged down in detail, albeit much of it necessary.

Both sides need to take a positive intent into the current talks and search for common goals and shared outcomes, for the sake of patients and contractors. The £645m needs to start to flow into the network very soon, and I’m sure that history will judge harshly any long delays that are seen by either side as being unwarranted.

It’s not just tortuous dances over service specs that should be consigned to the past. The 2011 NMS launch showed us that if payment structures are overly complicated, or contractors do not see the required activity as being fairly remunerated, the service will stall. 

We also need to ensure that there is enough kit available to deliver at the scale required by the market. When the blood pressure service was launched in 2021, there weren’t enough machines in the country to meet a fraction of the demand.

Mixed bag

When the CPCS was launched in November 2020, NHSE estimated that six per cent of GP consultations (20 million a year) could be safely transferred to community pharmacy. The service required that patients must first engage with another part of the system, and then be referred to a pharmacy. 

The problem was that it was launched without the engagement of the public or clinicians, and only a mixed bag of engagement with the seven NHS111 provider organisations. Not surprisingly, all this demonstrated was that if the method of receiving care is too complicated people will not engage.

Moreover, CPCS launched without any real targets. Without knowing where you are going, how can you ever expect to get there? In 2021/22, just over 700,000 patients were referred via CPCS – just 3.5 per cent of its potential. At the current rate of growth, it will take decades before CPCS can achieve the potential identified back in 2020.

NHSE has never appeared interested in setting meaningful incentives or targets to boost referrals into pharmacy. To be able to support any new initiative, businesses need to know what the scale of ambition and opportunity are. How much will they need to invest, and what are the possible returns? Come on commissioners, give us a clue!

Still, most pharmacies are keen to engage with new initiatives, as there is always the potential to boost patient outcomes and demonstrate their strengths to commissioners. But where there is no clarity around expectations, apathy can often ensue.

Remember Covid jabs? As I mentioned earlier, there was one occasion when an ambitious target was set, and community pharmacy overdelivered. In January 2021, Boris Johnson committed to vaccinating all of the most vulnerable in society within just six weeks. Fortunately, at the time, we had already been working with NHSE officials to develop a model for the supply of Covid vaccines from community pharmacies. The sector delivered – in spades.

We need to see some of that verve in NHSE’s latest plans. Pharmacy First must be commissioned with ambition. It must be easy for patients, professionals and systems to navigate. Remuneration must be simple – and fair. It must be commissioned at a scale to achieve the impact needed. Consideration must be given to the diagnostic equipment required and, above all, the NHS must publicly set itself ambitious targets.

If the negotiations can achieve all of this, the sector can and will deliver, and maybe – just maybe – we’ll see the dawn of a new age for community pharmacy. 

Malcolm Harrison is chief executive of the Company Chemists’ Association (CCA)